To: Parents & Guardians
Topic: Student Release Form – edTPA Teacher Certification Assessment
From: _____________________________________________ Teacher Preparation Program Candidate,
_____________________________________________ Institution
_____________________________________________ Cooperating/ Mentor Teacher
_____________________________________________ Building Principal
_____________________________________________ School
Date: ____________________________
I am a candidate in an initial teacher preparation program that is implementing the edTPA (Teacher Performance
Assessment), a national performance assessment for prospective teachers.
1 Successful completion of this assessment is a requirement for teacher certification in Georgia, beginning in August, 2015.
This project includes submission of short video recordings of my teaching in your child’s class. Although the video recordings involve both me and various students, the primary focus is upon my instruction, not on the students in the class. In the course of taping, your child may appear on the video recordings. The videotaped lesson will be used for me to reflect on my teaching practice as part of the edTPA and will be loaded in a secure, password-protected electronic course management system. Also, I may submit samples of student work as evidence of my teaching practice, and that work may include some of your child’s work. No student’s name will appear on any materials that are submitted.
Faculty, cooperating teachers, and/or teacher candidates associated with the program at
__________________________ (Institution) and faculty associated with edTPA may see my video and student work samples. These materials will be viewed only under secure, password-protected conditions, never posted on publicly accessible websites, and will never reveal identities of children, schools or districts.
This form continues on the next page and will be used to document your permission for your child’s participation in these activities.
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1 For more information about the edTPA, see http://edtpa.aacte.org/about-edtpa

To: Parents & Guardians
Topic: Student Release Form – edTPA Teacher Certification Assessment
From: _______________________________________ Teacher Preparation Program, Candidate
_______________________________________ Institution
_______________________________________ Cooperating/Mentor Teacher
_______________________________________ Building Principal
_______________________________________ School
Date: ______________
Student Permission Slip edTPA Teacher Certification Assessment Tasks
Please Complete and Return to your Child’s Teacher on or before _______________
Student Name:
I am the parent/legal guardian of the child named above. I have received and read your letter regarding a teacher assessment being conducted by ________________ (Institution), and I agree to the following: (Please initial either the I
DO or the I DO NOT box below.) My child will not be penalized if I choose “I DO NOT give permission.”
I DO give permission to include my child’s image on video recordings as he or she participates in class conducted at _____________________________________________School by ____________________
(Institution) and/or to reproduce materials that my child completed as part of classroom activities. No student names will appear on any materials submitted by the student teacher.
I DO NOT give permission to video record my child or to reproduce materials that my child may produce as part of classroom activities.
Parent/Guardian Signature Date:
Permission Slip for Students More Than 18 Years of Age
I am the student named above and am more than 18 years of age. I have read and understand the project description given above. I understand that my performance is not being evaluated by this project and that my last name will not appear on any materials that may be submitted. (Please initial either the I DO or the I DO NOT box below.) I will not be
penalized if I choose “I DO NOT give permission.”
I
DO give permission to you to include my image on video recordings as I participate in this class and/or reproduce materials that I may produce as part of classroom activities.
I DO NOT give permission to video record me or to reproduce materials that I may produce as part of classroom activities.
Student Signature: Date:
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